How should I manage Achilles tendinopathy?

Given that Achilles tendinopathy is localised pain in a single tendon, it seems as though it ought to be straightforward, yet it has been the focus of massive amounts of research into its pathology, its natural clinical course and its management.

Professor Peter Malliaras from Monash University makes sense of this mountain of evidence in his Invited Topical Review on physiotherapy management of this common and disabling condition.

After outlining the epidemiology, burden and clinical course of Achilles tendinopathy, the review turns to diagnosis and assessment.

Helpful visual algorithms are provided to guide clinicians through the steps and decisions.

The majority of the review is then devoted to clinical management from a physiotherapy perspective.

Several exercise approaches are reviewed as well as the effects of adjuncts to exercise.

Again, visual guides are provided to help clinicians tailor their exercise prescription appropriately.

An important theme throughout the review is a shift from a reductionist biomedical view towards a biopsychosocial view of Achilles tendinopathy, emphasising how this shapes current clinical care.

How helpful is it to incorporate ballistic resistance training in rehabilitation after traumatic brain injury?

Mobility limitations are common in people with a traumatic brain injury.

Although poor balance and spasticity are frequent factors, the main contributor to mobility limitations after traumatic brain injury is low muscle power generation.

It makes sense, then, to consider using ballistic resistance exercise in an attempt to improve mobility and balance, given its ability to improve muscle power generation in other patient groups.

Professor Gavin Williams presents his multicentre randomised trial that investigates the effect of replacing some traumatic brain injury rehabilitation with ballistic resistance training.

The incorporation of ballistic resistance training led to similar or better outcomes in the High-Level Mobility Assessment Tool known as HiMAT.

Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy.

A subgroup analysis showed that using ballistic resistance training in place of some non-ballistic exercise rehabilitation seems particularly useful among those with low baseline mobility.

How effective are plyometrics at preventing anterior cruciate ligament injury?

Anterior cruciate ligament (ACL) injuries are common in competitive sport and may have long-term sequelae such as post-traumatic knee osteoarthritis, re-injury fears and lifestyle modifications.

Multi-component injury prevention programs seem to reduce the risk of ACL injury but it is unclear which components need to be present.

A systematic review by Wesam Al Attar and colleagues pooled the available high-quality evidence about how the risk of ACL injury is affected by injury prevention programs that contain plyometric exercises.

Such programs reduce the risk of ACL injury by about 60 per cent relative to warm-up programs that do not include plyometric exercises.

The preventive effect appears to be stronger among men and in the prevention of those ACL injuries that do not involve contact with another player.

How could rating trials for the Physiotherapy Evidence Database benefit me?

The Physiotherapy Evidence Database (PEDro) is the most comprehensive resource to search for research into the effects of physiotherapy interventions.

It indexes randomised trials of physiotherapy interventions, systematic reviews of such trials and evidence-based clinical practice guidelines.

Unlike other databases, all trials indexed on PEDro are rated for methodological quality by at least two trained raters from around the world.

Four of these volunteer raters—from Brazil, Ukraine, Hong Kong and Australia—summarise the benefits of rating trials for PEDro.

They raise benefits that are obtained by all raters, such as receiving training in how to apply the PEDro scale correctly, enhancing research appraisal skills and keeping up to date with new research in areas that interest you.

The authors then discuss additional benefits specific to clinicians, to researchers, to students and to bilingual raters.

These and other original research papers are supplemented by a diverse range of critically appraised papers, clinical practice guidelines, clinimetric summaries of outcome measures and other appraisal items.

>> Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy. Follow him on Twitter @JOP_Editor and follow Journal of Physiotherapy @JPhysiother. Click here to read the research.